目的 了解四川省某县中老年HIV/AIDS患者污名化感知与焦虑、抑郁症状的现况及其关系,为提高中老年HIV/AIDS患者的心理健康水平提供科学依据.方法 将截至2019年6月在四川省泸州市泸县符合纳入标准的HIV/AIDS患者作为研究对象,采用面对面问卷调查,线性回归分析中老年HIV/AIDS患者污名化感知与焦虑、抑郁症状的关系.结果 共有498例HIV/AIDS患者纳入到本研究中,经问卷评估后,结果显示HIV/AIDS患者污名化感知总分为(33.33±7.94)分;63人(12.65％)存在焦虑症状;97人(19.48％)存在抑郁症状.多重线性回归分析发现,HIV/AIDS患者的焦虑症状与个人耻辱、负面自我形象、污名化感知总分呈正相关.其抑郁症状与个人歧视、负面自我形象、污名化感知总分呈正相关.结论 中老年HIV/AIDS患者的污名化感知总分与其焦虑、抑郁症状得分存在明显的相关关系,且污名化感知得分越高,其焦虑、抑郁症状越严重.中老年HIV/AIDS患者的污名化感知是其心理健康状况的重要影响因素,对中老年HIV/AIDS患者进行心理疏导降低其污名化感知,将有利于提高老年HIV/AIDS患者的心理健康水平.

目的 探讨四川省泸县中老年HIV/AIDS患者艾滋病疾病感知与心理健康的关系,为改善其心理健康状况提供新思路.方法 2019年6月,抽取四川省泸县20个乡镇中≥50岁的HIV/AIDS患者进行现场调查,调查工具选用病人健康问卷抑郁量表(PHQ-9)、广泛性焦虑障碍量表(GAD-7)、疾病感知问卷简化版(BIPQ),分析患者疾病感知现状及其与焦虑、抑郁症状的关系.结果 共调查498例中老年HIV/AIDS患者,焦虑总分为(2.93±5.07)分,存在焦虑症状者占12.65％;抑郁总分为(5.16±5.08)分,存在抑郁症状者占19.48％;BIPQ总分为(74.10±21.42)分.多因素分析结果显示,BIPQ总分与抑郁总分(β=0.26,P＜0.001)、焦虑总分(β=0.33,P＜0.001)呈正相关关系.结论 中老年HIV/AIDS患者焦虑、抑郁发生率高于社区老年人,BIPQ总分较高,而疾病感知与焦虑抑郁存在正相关关系,应对中老年HIV/AIDS患者采取综合干预措施,帮助其提高疾病正向感知力,降低焦虑、抑郁的发生率,从而改善其心理状况.

Abstract Background The number of older people living with HIV (PLWH) is increasing. Although there are many studies affecting medication adherence, research on the impact of social capital and mental health on medication adherence in this particular population is limited. Method Data were collected from an ongoing observational prospective cohort study, starting from November 2018, among older PLWH in Sichuan province, China. Five hundred twenty-one participants were interviewed. Social capital consists of the individual and family (IF) scale, and the community and society (CS) scale. The presence of probable depression and probable anxiety were assessed using the CES-D-10 and GAD-7 scales. Adherence was defined as taking ≥80% of prescribed HIV medication in 4 days prior to the interview. Two sets of Firth’ penalized regression analyses were used to estimate the association between social capital, mental health, and medication adherence. Results The prevalence of non-adherence was 18.2% (95/521) among older PLWH in this study. After adjusting for significant factors, the CS social capital (OR: 0.92, 95%CI:0.85–0.99, p < 0.05) and probable anxiety (OR:1.73, 95%CI:1.07–2.80, p < 0.05) were associated with non-adherence. Conclusion This study highlighted that the effects of social capital and mental health on older PLWH’s adherence, which implied that the need to develop interventions to concern for mental health and enhance CS social capital to help the older PLWH better manage HIV medication adherence.

目的 探索四川省某县50岁及以上HIV/AIDS患者的心理弹性与抗病毒治疗服药依从性的关系,为制定改善老年HIV/AIDS患者抗病毒治疗服药依从性现状的策略提供科学依据.方法 采用整群抽样方法抽取调查对象,应用中文版10条目心理弹性量表(CD-RISC-10)对调查对象进行心理弹性测试,并探索其与抗病毒治疗服药依从性的关系,采用SPSS 24.0进行描述性统计、单因素分析、多因素分析.结果 共调查493名患者,抗病毒治疗服药依从性好者占76.67％,依从性差者占23.33％,心理弹性总评平均得分(26.08±9.11)分.多因素分析结果显示心理弹性与抗病毒治疗服药依从性呈正相关关系(OR=1.04,95％CI:1.01～1.06,P＜0.01).结论 某县50岁及以上HIV/AIDS患者心理弹性水平相对较低,抗病毒治疗服药依从性有待提升,要进一步加强中老年HIV/AIDS患者的抗病毒治疗工作,为老年HIV/AIDS患者提供心理支持,提高其服药依从性,从而改善其健康状况.

ABSTRACT Medication adherence to antiretroviral therapy (ART) among elderly people living with HIV (PLWH) is of serious concern. Our study aimed to understand the medication adherence of elderly PLWH under ART based on the health belief model (HBM). A baseline survey with a total of 529 elderly PLWH was conducted in Sichuan. Logistic and linear regression analysis, mediation analysis, and path analysis based on prior evidence were used. Only self-efficacy showed direct associations with medication adherence in the last four days (ORm = 1.37, 95%CI: 1.11, 1.70) and the last month (ORm = 1.39, 95%CI: 1.18, 1.63) in the multivariate analysis. Self-efficacy mediated the relations between perceived benefits, perceived barriers, cues to action and medication adherence. Inner relations existed within the HBM. In addition to the direct effects, perceived benefits (β = 0.149, p = 0.031; β = 0.093, p = 0.005), perceived barriers (β = −0.070, p = 0.008; β = −0.062, p = 0.012), and cues to action (β = 0.184, p = 0.013; β = 0.135, p = 0.014) showed indirect effects on medication adherence in the last four days and the last month, respectively. HBM may be effective in predicting medication adherence of elderly PLWH, and self-efficacy may be a crucial predictor and mediator. Efforts should be focused on how to enhance elderly PLWH’s self-efficacy without neglect of other medication beliefs.

Background: Mental health problems are common among older people living with HIV and associated with poorer health outcomes. Social capital is an important determinant of mental health problems but under-studied in this population. This study investigated the association between social capital and mental health problems among older people living with HIV in China. Methods: The study was based on the baseline data of a cohort study investigating mental health among older people living with HIV in Sichuan, China during November 2018 to February 2019. Participants were people living with HIV aged ≥50 years living in Sichuan province. Stratified multi-stage cluster sampling was used to recruit participants from 30 communities/towns; 529 out of 556 participants being approached completed the face-to-face interview. Social capital was measured by two validated health-related social capital scales: the Individual and Family scale and the Community and Society scale. Presence of probable depression (CES-D-10 score ≥10) and probable anxiety (GAD-7 score ≥5) were used as dependent variables. Two-level logistic regression models were applied to examine the association between social capital and probable depression/anxiety. Results: The prevalence of probable depression and probable anxiety was 25.9% (137/529) and 36.3% (192/529) , respectively. After adjusting for significant covariates, the individual/family level of social capital was inversely associated with both probable depression (odds ratios (OR): 0.89, 95%CI: 0.84-0.93, p <0.001) and probable anxiety (OR: 0.90, 95%CI: 0.86-0.95, p <0.001). The community/society level social capital was associated with probable depression (OR: 0.91, 95%CI: 0.84-0.99, p <0.001) but not probable anxiety ( p >0.05). Conclusions: Interventions building up social capital should be considered to improve mental health of older people living with HIV. Some useful strategies include cognitive processing therapy, improving community networking and engagement, and promoting social bonding with neighborhood.

目的 调查四川省某艾滋病高流行县≥50岁的艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)的心理健康状况及其影响因素,为后期制定该人群心理干预措施提供科学依据.方法 2019年6月,抽取四川省某县20个乡镇中≥50岁的HIV/AIDS病人为研究对象,采用面对面问卷调查,分析中老年艾HIV/AIDS病人抑郁、焦虑症状现状及其影响因素.结果 共抽取498例HIV/AIDS病人中,采用问卷评估后,107人(21.5％)存在抑郁症状;117人(23.5％)存在不同程度的焦虑症状,其中54人(10.8％)存在轻度焦虑症状,36人(7.2％)存在中度焦虑症状,27人(5.4％)存在重度焦虑症状.Logistic回归分析发现:年龄[50～59岁与≥70岁相比,比值比(OR)=3.691]、月收入(＜1000元与≥2 000元相比,OR=2.409)对抑郁症状有影响;年龄(50～59岁与≥70岁相比,OR=3.843),工作状况(无业/失业与在业相比,OR=2.521),外出务工(从未外出务工与过去在外务工,现在回家发展相比,OR=1.736)对焦虑症状有影响.结论 中老年HIV/AIDS病人抑郁和焦虑症状的发生率较高,应该引起关注,尤其应重点关注50～59岁、无业或失业、低收入、无外出务工经历者,有针对性地进行健康教育和心理疏导,降低其抑郁和焦虑症状的发生率,改善心理健康状况.

目的 了解四川省泸县≥50岁艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)艾滋病相关社会规范及与最近6个月性行为中安全套使用行为的关系,为安全性行为干预策略提供参考.方法 采用自行设计的问卷开展一般人口学特征、艾滋病相关特征、艾滋病相关社会规范的调查.采用t/x2检验、二元Logistic回归模型分析社会规范对安全套使用行为的影响.结果 共调查498名≥50岁的HIV/AIDS病人,平均年龄(65.29±7.57)岁,男性372名,女性126名.与艾滋病传播认知有关的社会规范得分越高["坚持使用安全套"组为(4.71±0.57)分,"未坚持使用安全套"组为(4.09±0.95)分,比值比(OR)=1.830,95％可信区间(CI):1.037～3.230],与安全套使用有关的社会规范得分越高["坚持使用安全套"组为(11.33± 3.00)分,"未坚持使用安全套"组为(8.33±2.83)分,OR=1.404,95％CI:1.202～1.639]、年龄越小(≤60岁组"坚持使用安全套"率为63.79％,＞60岁组"坚持使用安全套"率为34.02％,OR=0.253,95％CI:0.109～0.590)、性别为男性(男性"坚持使用安全套"率为50.00％,女性"坚持使用安全套"率为31.71％,OR=3.227,95％CI:1.255～8.299)、婚姻状况为已婚且与配偶居住(已婚且与配偶居住组"坚持使用安全套"率为51.82％,未婚/离异/分居/丧偶组"坚持使用安全套"率为28.89％,OR=2.863,95％CI:1.124～7.294)的中老年HIV/AIDS病人越倾向于在性行为中坚持使用安全套.结论 中老年HIV/AIDS病人艾滋病相关社会规范与安全套使用行为相关.